scholarly journals Prognostic Risk Factors for Complications Associated with Below the Knee Amputations

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0037
Author(s):  
Jason Ni ◽  
Eric Lukosius ◽  
Kaitlin Saloky ◽  
Kempland Walley ◽  
Leanne Ludwick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Charlson Comorbidity Index ◽  
High Rate ◽  
Tourniquet Time ◽  
Ambulatory Status ◽  
Asa Classification ◽  
Below The Knee ◽  
Comorbidity Index ◽  
Prognostic Risk Factors

Category: Other Introduction/Purpose: Below the knee amputation (BKA) is an effective surgical procedure for individuals with severe injury or infection to their lower extremities. However, patients who receive these procedures are subject to significant morbidity and a high rate of postoperative complications due to the presence of multiple concomitant comorbidities. Despite the wide practice of this intervention, prognostic risk factors aiding in predicting surgical outcomes in these patients are poorly understood. The purpose of this study is to evaluate risk factors that may contribute to the outcomes of BKA procedures. Methods: The clinical and radiographic outcomes for 89 patients ages 19-90 who underwent BKA were retrospectively evaluated from 2012-2017. Postoperative complications of mortality, infection, and reoperation were evaluated with patient and surgical variables. Patient variables included: age, ambulatory status, obesity, diabetes, HbA1C2 levels, neuropathy, smoking, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) classification. Surgical variables evaluated included: presence of pre-op infection, pre-op ambulatory status, tourniquet time, tourniquet pressure, and usage of prophylactic antibiotics. Results: Of the patients evaluated there was an overall complication rate of 49% (44/89) and a mortality rate of 19% (17/89). Patients with diabetes (p=.035), a greater score on the Charlson Comorbidity Index (p=.001), and an ASA classification =3 (p=.005) were associated with a greater risk of mortality. Operative values (i.e. tourniquet time, tourniquet pressure etc.) did not affect patient mortality rates in a significant way, but there was a higher incidence of complications (i.e. mortality, post-op infections, and reoperations) with patients with pre-operative infections. Conclusion: Diabetes, a higher CCI score and a greater ASA value were found to be significant predictors of patient mortality after BKA (p<0.05). Future perioperative optimization in these patients identified as high risk may improve patient outcomes in the future.

scholarly journals Charlson Comorbidity Index Is Predictive of Postoperative Clinical Outcome After Single Level Posterior Lumbar Interbody Fusion Surgery: a Single-center Study

2021 ◽  
Author(s):  
Kensuke Shinohara ◽  
Ryo Ugawa ◽  
Shinya Arataki ◽  
Shinnosuke Nakahara ◽  
Kazuhiro Takeuchi
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Direct Cost ◽  
Charlson Comorbidity Index ◽  
Japanese Orthopaedic Association ◽  
Negative Relationship ◽  
Improvement Rate ◽  
Single Level ◽  
Comorbidity Index ◽  
Group 2

Abstract Background. In several previous studies Charlson comorbidity Index (CCI) score was associated with postoperative complications, mortality and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF.Methods. 366 patients who underwent an elective primary single level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1 and 2+). JOA improvement rate, length of stay (LOS) and direct cost were compared between each group. Postoperative complications were also investigated.Results. There was a weak negative relationship between CCI score and JOA improvement rate (r = -0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of Group 0 and Group 1 was significantly higher than Group 2+. LOS and direct cost were also significantly different etween Group 0 and Group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities.Conclusions. A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.

scholarly journals Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

2017 ◽  
Vol 11 (12) ◽  
pp. 388-93 ◽  
Author(s):  
Max A. Levine ◽  
Trevor Schuler ◽  
Sita Gourishankar
Keyword(s):  
Logistic Regression ◽  
Postoperative Complications ◽  
Renal Transplant ◽  
Postoperative Period ◽  
Charlson Comorbidity Index ◽  
Significant Risk ◽  
Patient Counselling ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Relationship Of

Introduction: Renal transplant experiences widespread success, but little is published regarding the postoperative complications. The Charlson Comorbidity Index (CCI) is a system of mortality risk assessment. Our purpose is to assess the 90-day postoperative complications after renal transplantation. The secondary objective is to clarify whether CCI predicts complications. We hypothesized increased CCI corresponds to worse complication on the Clavien scale.Methods: This is a retrospective analysis of renal recipients at our institution (2011‒2013) who were ≥18 years old and received complete follow up. CCI, age, gender, body mass index (BMI), and graft type were extracted from the electronic medical records. Complications were scored using the Clavien scale. Descriptive statistics and logistic regression were used to analyze 198 patients.Results: The mean age was 53 (standard deviation [SD] 14), mean BMI 27.4 (SD 14), median CCI 1. Grade 2 or higher (significant) complications occurred in 60% of patients and Grade 3b or higher (severe) in 15% of patients in the 90-day postoperative period. Sixty-eight different complications were identified, the most common being blood transfusion (19%). Logistic regression suggests a predictive value of CCI (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.3‒2.3) for severe complications, with diabetes mellitus and peripheral vascular disease conferring increased risk. Conclusions: Renal transplant carries significant risk. This data can be used to improve patient counselling on the likely postoperative course. Study limitations include the retrospective design, predisposing to potential bias in data capture.

Postoperative complications and 90-day mortality in radical cystectomy in high-risk patients: A monocentric retrospective observational study

2018 ◽  
Vol 85 (3) ◽  
pp. 111-117 ◽  
Author(s):  
Carlo Pavone ◽  
Luigi Candela ◽  
Dario Fontana ◽  
Alchiede Simonato
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Observational Study ◽  
Radical Cystectomy ◽  
Charlson Comorbidity Index ◽  
Odds Ratio ◽  
Retrospective Observational Study ◽  
High Risk Patients ◽  
Risk Patients ◽  
Comorbidity Index

Aim: Assessing the incidence of immediate postoperative complications and 90-day mortality in high-risk patients who have undergone radical cystectomy; evaluating the correlation between preoperative conditions and surgery outcomes. Materials and methods: This is a monocentric retrospective observational study in which data of 65 patients have been analyzed. High-risk criteria: (a) Age ≥75 years, (b) obesity, (c) age-adjusted Charlson Comorbidity Index ≥8, (d) anemic status, and (e) pT ≥3. More than 50% of patients had two or more “high-risk” indicators. Postoperative complications were assessed through Clavien–Dindo classification. Results: Average age of patients was 70.4 years, average age-adjusted Charlson Comorbidity Index was 5.8, and average body mass index was 27.5. In 28% of patients, no complications arose, while in 46% grades I–II complications according to Clavien–Dindo occurred, in 23% grades III–IV complications occurred, and in 3% of the patients, death arose in the immediate postoperative period (grade V). Overall, 90-day mortality rate after surgery was 12.3%. The age ≥75 years and an age-adjusted Charlson Comorbidity Index score ≥8 have shown to be risk factors for the onset of severe complications (odds ratio = 3.54, p = 0.028 and odds ratio = 4.7, p = 0.026), while preoperative anemic status was a risk factor for complications in general (odds ratio = 4.1, p = 0.015). No analyzed parameter was a predictor of 90-day mortality ( p > 0.05). Conclusion: Immediate postoperative complications and 90-day mortality in radical cystectomy in high-risk patients remain significant, but still in line with the data in the literature on comparable populations. Some of the preoperative parameters were able to predict the outcomes of the intervention with regard to the onset of complications but not to the 90-day mortality.

scholarly journals 322. Risk Factors for COVID-19 Disease Severity Using Electronic-Health Records in a Real-World Cohort in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S266-S267
Author(s):  
Shemra Rizzo ◽  
Ryan Gan ◽  
Devika Chawla ◽  
Kelly Zalocusky ◽  
Xin Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Electronic Health Records ◽  
Confidence Intervals ◽  
Disease Severity ◽  
Charlson Comorbidity Index ◽  
Severe Disease ◽  
Older Age ◽  
Calendar Time ◽  
Health Records ◽  
Comorbidity Index

Abstract Background Over 32 million cases of COVID-19 have been reported in the US. Outcomes range from mild upper respiratory infection to hospitalization, acute respiratory failure, and death. We assessed risk factors associated with severe disease, defined as hospitalization within 21 days of diagnosis or death, using US electronic health records (EHR). Methods Patients in the Optum de-identified COVID-19 EHR database who were diagnosed with COVID-19 in 2020 were included in the analysis. Regularized multivariable logistic regression was used to identify risk factors for severe disease. Covariates included demographics, comorbidities, history of influenza vaccination, and calendar time. Results Of the 193,454 eligible patients, 36,043 (18.6%) were hospitalized within 21 days of COVID-19 diagnosis, and 6,397 (3.3%) died. Calendar time followed an inverse J-shaped relationship where severe disease rates rapidly declined in the first 25 weeks of the pandemic. BMI followed an asymmetric V-shaped relationship with highest rates of disease severity observed at the extremes. In the multivariable model, older age had the strongest association with disease severity (odds ratios and 95% confidence intervals of significant associations in Figure). Other risk factors were male sex, uninsured status, underweight and obese BMI, higher Charlson Comorbidity Index, and individual comorbidities including hypertension. Asthma and overweight BMI were not associated with disease severity. Blacks, Hispanics, and Asians experienced higher odds of disease severity compared to Whites. Figure. Significant associations (odds ratio and 95% confidence intervals) with COVID-19 severity (hospitalization or death), adjusted for geographical division. Reference and abbreviation categories: Charlson comorbidity index (CCI) = 0; Age = 18-30; Sex = Female; Race/Ethnicity = White; Insurance = Commercial; Body mass index (BMI) = 18.5-25; Calendar time = 0-25 weeks; Chronic obstructive pulmonary disease (COPD). Conclusion Odds of hospitalization or death have decreased since the start of the pandemic, with the steepest decline observed up to mid-August, possibly reflecting changes in both testing and treatment. Older age is the most important predictor of severe COVID-19. Obese and underweight, but not overweight, BMI were associated with increased odds of disease severity when compared to normal weight. Hypertension, despite not being included in many guidelines for vaccine prioritization, is a significant risk factor. Pronounced health disparities remain across race and ethnicity after accounting for comorbidities, with minorities experiencing higher disease severity. Disclosures Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Ryan Gan, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Xin Chen, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Yifeng Chia, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee)

scholarly journals Sarcopenia and Charlson Comorbidity Index are Risk Factors for Short-Term Postoperative Prognosis of Elderly Patients with Gastrointestinal Tumor: A Retrospective Study

2021 ◽  
Author(s):  
Jiaqiu Wang ◽  
Liqian Xu ◽  
Shunmei Huang ◽  
Quan Hui ◽  
Xuexue Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Charlson Comorbidity Index ◽  
Older Patients ◽  
Gastrointestinal Tumor ◽  
Short Term ◽  
Postoperative Prognosis ◽  
History Of ◽  
Comorbidity Index ◽  
Independent Risk Factors

Abstract Background Sarcopenia is one of the most common syndromes in the older adults. Gastrointestinal tumor is a malignant disease with high incidence. This study aimed to investigate the risk factors of sarcopenia in older adults with gastrointestinal tumor, the prognostic indicators of and short-term outcomes after resection for gastrointestinal tumor, and to explore the relationship between sarcopenia and short-term postoperative prognosis.Method A total of 247 older patients with gastrointestinal tumors who underwent radical resection in 2019 were included in this study. Relevant indexes were calculated using L3 slice image of computed tomography (CT) to evaluate sarcopenia. Short-term postoperative complications and length of stay were considered as short-term outcome of this study.Results Advanced age, lower higher body mass index (BMI), lower hemoglobin, having history of abdominal surgery and higher visceral fat index (VFI) were risk factors of sarcopenia, while higher BMI and lower subcutaneous fat index (SFI) were protective factors of sarcopenia. Further multivariate logistic regression analysis showed that having history of abdominal surgery, advanced age and lower BMI were independent risk factors. Sarcopenia and higher Charlson comorbidity index were independent risk factors of short-term postoperative complications in the elderly with gastrointestinal tumor. Higher Charlson comorbidity index gave rise to longer length of stay.ConclusionsSarcopenia and higher Charlson comorbidity index predict poor short-term prognosis of older patients undergoing gastrointestinal tumor resection.

The impact of polypharmacy and comorbidities on surgical morbidity and mortality in patients with gynecological malignancies: Results of a prospective study in 237 patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18255-e18255
Author(s):  
Guelhan Inci ◽  
Hannah Woopen ◽  
Rolf Richter ◽  
Radoslav Chekerov ◽  
Mustafa Zelal Muallem ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Charlson Comorbidity Index ◽  
Clinical Characteristics ◽  
Gynecologic Cancer ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Duration Of Surgery ◽  
Comorbidity Index ◽  
The Impact ◽  
Preoperative Albumin

e18255 Background: Physicians need to risk-stratify their patients preoperatively to adjust the radicality and the indication of surgery. So far, there are only retrospective and limiting data available. Aim of this study is to evaluate the predictive clinical characteristics such as polypharmacy and Charlson-Comorbidity Index (CCI) for postoperative complications in patients undergoing gynecologic cancer surgery. Methods: This is a prospective cohort study of patients undergoing gynecologic cancer surgery at a tertiary care academic center from October 2015 through January 2017. Surgical complications were graded using validated Clavien-Dindo criteria. Using logistic regression, we identified demographic and predictive clinical characteristics for postoperative complications. Results: Out of the 237 enrolled patients 41(17.3%) experienced a grade≥3b complication. Within 30 days of surgery, 9 (3.8%) patients has died. Charlson Comorbidity index (CCI)> 2(p<0.015, OR 2.33, 95% CI 1.18-4.61), polypharmacy (p<0.001, OR 3.40, 95% CI 1.63-7.10), ASA (p<0.0001, OR 2.98, 95% CI 1.65-5.38), BMI>25kg/m2 (p<0.001, OR 4.25, 95% CI 1.86-9.69), preoperative albumin<3.5 g/dl (p<0.009, OR 3.22, 95% CI 1.33-7.79) and potassium < 3.6 mmol/L (p=0.007, OR 5.11, 95% CI 1.55-16.81) were predictive for complications grade≥3b. A multivariable model included duration of surgery (p=0.012, OR 1.26, 95% CI 1.05-1.52), ASA (p=0.01, OR 2.60, 95% CI 1.20-5.60), preoperative albumin<3.5 g/dl (p=0.028, OR 3.37, 95% CI 1.14-10.00), BMI >25kg/m2 (p=0.009, OR 3.81, 95% CI 1.40-10.35) and potassium < 3.6 mmol/L (p=0.02, OR 3.69, 95% CI 1.20-11.38) was predictive of 30-day Morbidity and Mortality. Age (p=0.49, OR 0.89, 95% CI 0.95-1.02), CCI > 2(p=0.88, OR 1.06, 95% CI 0.42-2.69) and polypharmacy (p=0.65, OR 1.26, 95% CI 0.41-3.98) showed no association for postoperative complications. Conclusions: Only ASA, BMI, preoperative albumin and potassium are associated with severe postoperative complications in patients undergoing gynecologic cancer surgery. Subsequent studies should confirm this result to identify better frail cancer patients.

Predictors of Survival After Surgical Treatment of Spinal Metastasis

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 674-681 ◽  
Author(s):  
Robert T Arrigo ◽  
Paul Kalanithi ◽  
Ivan Cheng ◽  
Todd Alamin ◽  
Eugene J Carragee ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Spinal Metastasis ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Ambulatory Status ◽  
Hazards Model ◽  
Comorbidity Index

Abstract BACKGROUND: Surgery for spinal metastasis is a palliative treatment aimed at improving patient quality of life by alleviating pain and reversing or delaying neurologic dysfunction, but with a mean survival time of less than 1 year and significant complication rates, appropriate patient selection is crucial. OBJECTIVE: To identify the most significant prognostic variables of survival after surgery for spinal metastasis. METHODS: Chart review was performed on 200 surgically treated spinal metastasis patients at Stanford Hospital between 1999 and 2009. Survival analysis was performed and variables entered into a Cox proportional hazards model to determine their significance. RESULTS: Median overall survival was 8.0 months, with a 30-day mortality rate of 3.0% and a 30-day complication rate of 34.0%. A Cox proportional hazards model showed radiosensitivity of the tumor (hazard ratio: 2.557, P &lt; .001), preoperative ambulatory status (hazard ratio: 2.355, P = .0001), and Charlson Comorbidity Index (hazard ratio: 2.955, P &lt; .01) to be significant predictors of survival. Breast cancer had the best prognosis (median survival, 27.1 months), whereas gastrointestinal tumors had the worst (median survival, 2.66 months). CONCLUSION: We identified the Charlson Comorbidity Index score as one of the strongest predictors of survival after surgery for spinal metastasis. We confirmed previous findings that radiosensitivity of the tumor and ambulatory status are significant predictors of survival.

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